Form 2699 - Statement Of "Qualified Personal Property" By A "Qualified Business" - 2011
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Michigan Department of Treasury
L-4143
2699 (Rev. 10-10)
2011 Statement of "Qualified Personal Property"
by a "Qualified Business" (as of 12-31-10)
This form is issued under authority of the General Property Tax Act (P.A. 206 of 1893). This statement is subject to audit.
INSTRUCTIONS: This form must be completed and filed with the assessor no later than February 1, 2011. A "qualified business"
(defined on reverse side) that wishes to have users be assessed for "Qualified Personal Property" (defined on reverse side) in
2010 must complete this form and file it with the assessor no later than February 1, 2011. If this form is not filed by February
1, 2011, or if property is not included on the form, then the property is assessable in 2011 to the company that makes the
property available, rather than to the user. This statement must be filed in each township and city where property is located
using the format below. This statement must have assets grouped (in alphabetical order) by the user responsible for paying tax.
You may not list property subject to an agreement (frequently titled a lease) entered into before January 1, 1994. The
"qualified business" must also file Form L-4175 (Form 632) if it is the owner of property that is not "qualified property"
or if the assessor sends a Form L-4175 for completion.
Name of "Qualified Business"
Mailing Address (Street or RR#, City, State, ZIP)
Is the "Qualified Business" a manufacturer of personal property?
(See instruction #2)
Telephone Number
Yes
No
Name of Person to Contact
Place where records are kept
Telephone Number
Name of Township or City where the property is located on December 31, 2010
Periodic
Frequency of
User's Name and Street Address
Description of Equipment
Purchase Price
Year of
Payment
Payment
Where Property is Located (see inst. #4)
and Model or Serial No.
(see inst. #3)
Purchase
by User
(see inst. #5)
Attach additional schedules on Form 4143a, if necessary, following the same reporting format.
Notary Public, State of Michigan
ss
County of ______________________________________________
I, _______________________________________________________,
being duly sworn, depose and say that the company
which I represent is a qualified business as defined in Section 8a of P.A. 206 of 1893, as amended and that the personal
property reported on this form is qualified personal property as defined in Section 8a of P.A. 206 of 1893, as amended.
Subscribed and sworn to before me this ___________________
Signed _______________________________________________
day of ____________________________________, 20 ______
Title _________________________________________________
Must be Signed by Owner, Partner or Corporate Officer or a duly
___________________________________________________
authorized agent.
My Commission Expires _______________________________
Signature of Preparer ___________________________________
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